NHS chiefs sound alarm about Brexit impact on health workforce

LONDON — Brexit uncertainty is already draining the U.K.s National Health Service of European doctors and nurses, hospital bosses warned Tuesday.

A new survey of 68 NHS hospitals and other care institutions, seen by POLITICO, found one in five have already altered recruitment plans because of Brexit, despite the U.K. not being scheduled to leave for another year.

More than a third say the impact of Brexit has been negative for their workforce, and nearly half say that — less than a year from exit day — the lack of clarity on negotiations with the EU means it is still too early to predict how their staff might be affected once the U.K. actually leaves the bloc.

The NHS is heavily reliant on non-British European doctors and nurses. In total, 62,000 non-British European nationals work for the NHS in England, more than 5 percent of the overall workforce, and the figure is as high as 20 percent in some organizations.

The study, carried out by the Cavendish Coalition, which includes umbrella organizations NHS Providers, NHS Employers and the Shelford Group, who speak on behalf of hospitals and other frontline care providers, also shows that despite Prime Minister Theresa May winning an agreement to safeguard the rights of EU citizens in the U.K. once Britain leaves the bloc, only 16 percent of hospital bosses think their EU staff welcomed the deal. Most respondents said the fact that it is nonbinding and the fractious state of the wider Brexit negotiations makes it too early to offer guarantees about EU citizens status.

One of the key drivers of support for Brexit, according to polls, was improved funding for the U.K.s taxpayer-funded health service. The Vote Leave campaign claimed free movement from the EU is creating unsustainable demands on health services and said money repatriated from the EU budget could be spent on the NHS.

While Mays government has indicated it will deliver on that promise with a major, long-term funding injection for the NHS this year, it now faces the prospect of a Brexit-related workforce crisis — something the NHS, which already has 100,000 vacancies in England, can ill afford.

In a blog to accompany the new survey — the latest of a quarterly series, carried out in February 2018 — NHS Providers warn that, beyond the immediate problems of retaining and recruiting EU staff, the NHS will not completely fill nursing and care staff rosters after Brexit with domestically trained workers — despite a government pledge to train more British nurses.

They therefore urge the Home Office not to propose migration caps on low-paid health and care workers in its Immigration White Paper, expected by the end of this year, which will be the blueprint for the U.K.s post-Brexit immigration system.

“The U.K. cannot fill its sizeable nursing and social care vacancies domestically, and EU nationals willing to take up these low-paid roles should not be prevented from doing so by caps based on earning potential,” write NHS Providers adviser Kerry Racher and research analyst Rhiannon Edge.

“What is clear is that European and international staff will remain vital to the NHS, life sciences and social care services in the years to come,” they add. “Continued uncertainty is damaging to the quality of patient care. The longer it goes on, the greater the risk that some services will no longer be viable.”

The warning comes amid growing evidence of EU-born workers — particularly nurses — leaving the NHS workforce in growing numbers, while at the same time hospitals face greater difficulties in persuading EU nationals to work in the health and care sectors because of uncertainty about their future immigration status.

Latest NHS Digital workforce data shows that 3,955 EU27-nationality NHS nurses left the health service in England between September 2016 and September 2017, up from 3,078 in the previous 12-month period. Even more drastically, the number of EU nurses joining the NHS in England fell from 5,946 to 2,776 in the same period.

Meanwhile, new figures released last week by the professional regulator, the Nursing and Midwifery Council, also show the number of nurses and midwives from EU countries joining the U.K. register fell from 6,382 between April 2016 and March 2017, to just 805 in the past year — an 87 percent drop. The numbers leaving the register rose from 3,081 to 3,962 in the same period.

Health Secretary Jeremy Hunt announced a 25 percent increase in training places for nurses in October 2017; however, in its evidence to the independent Migration Advisory Committee — which is preparing a report on EU migration to inform the governments immigration White Paper — the Department of Health said there is “a lag in the time it takes to train a new member of staff … and therefore continued migration across the NHS is vital to maintain service levels.”

Kelvin Cheatle, director of workforce at Kingston Hospital NHS Foundation Trust in southwest London, which employs 480 EU workers out of a total roster of 3,000, said the trusts turnover of staff has doubled since the Brexit vote from between 12 and 15 percent annually, to 26 percent. Between 10 and 12 EU staff members have left the trust each month — double the numbers departing before the June 2016 referendum.

“We work very hard filling posts, but we are filling the bath with the plug out. As quickly as you recruit, you are losing people,” Cheatle said. “Partly thats pay, partly thats the pressure of the work, but Brexit we could have done without … No one said to voters that yes we could put more money in, but it also could lead to a drain of qualified nursing staff. But thats the real and present danger were dealing with.”

He added that despite a pre-referendum recruitment drive in Spain, Portugal and Ireland — itself a response to domestic shortages and restrictions on recruitment from non-EU countries — it has now become “very difficult” to attract people from the EU27 to the U.K.

Recent revelations that legal Caribbean migrants who moved to Britain decades ago — the so-called Windrush generation — have been ordered to leave the country because they do not have the correct documentation, have increased anxiety among the hospitals EU staff that even if their residency status is secured after Brexit, they could be subject to bureaucratic errors when registering, Cheatle said.

The Home Office and the Department of Health did not respond to requests for comment.